The value of in-patient dermatology: a survey of in-patients in Scotland and Northern England

Profile of dermatology inpatients and admissions over a four year period in a tertiary level government teaching hospital in North India

BACKGROUND

Although dermatology is mostly an outpatient specialty, some patients with severe skin disease need hospital admission for management. There is a paucity of data regarding the profile of these dermatology in-patient admissions.

AIMS

We studied the profile of patients admitted to the dermatology ward of our tertiary care government hospital in North India.

METHODS

This was a retrospective analysis of discharge sheets of patients admitted in the dermatology ward from January 1, 2014 to December 31, 2017.

RESULTS

Discharge sheets of 2032 admissions for 1664 patients were analyzed. The most common diagnoses in the admitted patients were immunobullous disorders (576, 28%), connective tissue diseases (409, 20%), infections, including leprosy and sexually transmitted infections (179, 8.8%), psoriasis (153, 7.5%) and reactive arthritis (92, 4.5%). The mean duration of admission was 13.95±11.67 days (range 1-118 days). Two hundred and fifty-six patients (15.38%) were re-admitted, accounting for 368 (18.11%) re-admissions. Patients with immunobullous disorders (OR 1.72, 95% CI 1.29-2.28) and psoriasis (OR 1.62, 95% CI 1.02-2.55) were more likely to be re-admitted. Adult patients, those who were admitted for more than four weeks, those who had comorbidities, and those who developed a complication during the hospital stay also had a greater likelihood of being re-admitted.

LIMITATIONS

The retrospective design of the study, and the non-availability of data regarding transfers to other specialties or intensive care units and deaths were the main limitations of this study.

CONCLUSION

This study describes the profile of patients admitted in a dermatology ward of a tertiary care centre center in North India. The patient profile and admission characteristics associated with a higher probability of re-admission were identified.

Inpatient dermatology: Where are we headed? A nationwide population-based study of Spain from 2006 to 2016

BACKGROUND AND OBJECTIVES

Information about hospital admissions for skin diseases is restricted to studies describing admissions to single centers, to specific wards, or only for a few diagnoses, and there is no information about the outcomes between different wards. The aim of this research is to describe hospital admissions due to dermatological diseases.

PATIENTS AND METHODS

Cross-sectional study of hospital discharges at Spanish hospitals. Discharges were assumed to be the same as admissions.

RESULTS

519,440 discharges (1.1 % of total discharges) were identified. Most admissions (60.1 %) were done from emergency departments. Only 7 % of cases were admitted to dermatology wards. The most prevalent group was cellulitis and acute lymphangitis. Median age was 57 years, and men were more common. The median length of hospital stay was four days; 40,823 (7.9 %) cases required readmission. There were 13,558 (2.6 %) hospital deaths. After adjusted analysis (by age, sex and group of diagnosis), the OR of readmission was 1.49 (95 % CI: 1.42-1.57) times higher and length of stay was 0.22 (95 % CI: 0.15-0.29) days longer in non-dermatology wards (P < 0.0001). From 2006-2016, admissions to dermatology wards decreased 38 %, while in non-dermatology wards they increased 8 %.

CONCLUSIONS

A non-negligible number of patients require dermatological inpatient management. This is mainly provided by non-dermatologists. Some of our findings may indicate an improved overall care by dermatologists.

Seasonality of the hospitalizations at a dermatologic ward (2007-2017)

There is little data in the literature concerning dermatologic admissions. Several diseases are seasonal in incidence and clinical worsening. We performed a survey of hospitalizations in the dermatology ward of a public hospital (April/2007 to May/2017). There were 1790 hospitalizations, whose main diagnoses were infectious dermatoses, neoplasias, psoriasis, bullous diseases and cutaneous ulcers. In winter, there were fewer hospitalizations for bacterial infections and urticaria, but more for leprosy. In summer, there were fewer hospitalizations for systemic and subcutaneous mycoses, but more for zoodermatoses and erythema multiforme. In the fall, more patients were admitted with mycoses. Spring favored urticaria and angioedema, but less cases of erythema multiforme and diabetic foot.

Inpatient Dermatology: Characteristics of Patients and Admissions in a Tertiary Level Hospital in Eastern India

Introduction:

Dermatology is primarily a non-acute, outpatient-centered clinical specialty, but substantial number of patients need indoor admission for adequate management. Over the years, the need for inpatient facilities in Dermatology has grown manifold; however, these facilities are available only in some tertiary centers.

Aims and Objectives:

To analyze the characteristics of the diseases and outcomes of patients admitted in the dermatology inpatient Department of a tertiary care facility in eastern India.

Materials and Methods:

We undertook a retrospective analysis of the admission and discharge records of all patients, collected from the medical records department, admitted to our indoor facility from 2011 to 2014. The data thus obtained was statistically analyzed with special emphasis on the patient's demographic profile, clinical diagnosis, final outcome, and duration of stay.

Results and Analysis:

A total of 375 patients were admitted to our indoor facility during the period. Males outnumbered females, with the median age in the 5th decade. Immunobullous disorders (91 patients, 24.27%) were the most frequent reason for admissions, followed by various causes of erythroderma (80 patients, 21.33%) and infective disorders (73 patients, 19.47%). Other notable causes included cutaneous adverse drug reactions, psoriasis, vasculitis, and connective tissue diseases. The mean duration of hospital stay was 22.2±15.7 days; ranging from 1 to 164 days. Majority of patients (312, 83.2%) improved after hospitalization; while 29 (7.73%) patients died from their illness. About 133 patients (35.64%) required referral services during their stay, while 8 patients (2.13%) were transferred to other departments for suitable management.

Conclusion:

Many dermatoses require inpatient care for their optimum management. Dermatology inpatient services should be expanded in India to cater for the large number of cases with potentially highly severe dermatoses.

Patterns of inpatient dermatology referral and predictors of diagnostic accuracy in non-dermatologists in a Northern District hospital in Singapore

BACKGROUND

A wide range of dermatological conditions is often encountered in the inpatient setting. Many non-dermatologists experience difficulty in their diagnosis, and referral to a dermatologist is often warranted. In our local setting, this is made through a formal written referral letter, which is usually drafted by the junior doctor on the team.

OBJECTIVES

This study was conducted to characterize patterns of inpatient dermatology referral and to investigate whether predictors of diagnostic concordance between the referring non-dermatologist and the reviewing dermatologist can be identified.

METHODS

A total of 168 inpatient dermatology referrals made between June and September 2013 at a Northern District hospital in Singapore were identified and reviewed. Collated variables were broadly divided into: (i) patient demographic details; (ii) the referring details of non-dermatologists; and (iii) the response details of reviewing dermatologists.

RESULTS

No predictors of diagnostic concordance could be identified statistically. A total of 90.5% (n = 152) of referrals were made for both diagnostic and management purposes, whereas 9.5% (n = 16) of referrals were made purely for management purposes. Of the 152 diagnostic and management referrals, a preliminary diagnosis was reflected in 69.1% (n = 105). In 47.6% of all referrals (n = 80), more than one dermatological condition was identified. The fungal smear was the most commonly requested ancillary investigation (22.6%, n = 38/168). Cutaneous skin infections (32.0%, n = 85/266) and endogenous eczema (32.0%, n = 85/266) were by far the two most commonly identified dermatological conditions in our local cohort of patients.

CONCLUSIONS

The need for a dedicated inpatient dermatology service is reinforced. However, targeted education may be employed to facilitate the referral process.

Inpatient dermatology: profile of patients and characteristics of admissions to a tertiary dermatology inpatient unit in São Paulo, Brazil

BACKGROUND

Dermatology is primarily an outpatient clinical and surgical specialty, but substantial numbers of patients are admitted to hospital for inpatient treatment in dermatology wards.

METHODS

We performed a retrospective study of patients admitted to dermatology beds between September 1, 2002, and September 30, 2010. Patient data were analyzed for age, gender, ethnicity, length of stay (LoS), dermatologic disease, comorbidities, hospital-acquired infection (HAI), transfer to the intensive care unit (ICU), and mortality.

RESULTS

A total of 3308 patients admitted during this 8-year period were identified for analysis. The most frequent admissions were for eczema/dermatitis (17.5%) and cutaneous infections (15.9%). The mean LoS was 13.0 days. The mean ± standard deviation (SD) number of comorbidities per patient was 1.0 ± 1.2, among the most frequent of which were hypertension and diabetes mellitus. The rate of HAI was 6.2%; bloodstream infection was regarded as the most commonly acquired type and Staphylococcus aureus as the infectious agent most commonly found in culture. Of the patients admitted, 3.7% were transferred to the ICU and 2.5% died. In these latter two groups, the most common dermatologic diagnoses were immunobullous diseases, and the mean hospital LoS and rate of HAI were higher than in the total admissions cohort.

CONCLUSIONS

Higher value should be placed on dermatology inpatient services in order to expand the availability of dermatology beds, mainly in tertiary hospitals, in view of the potentially high severity of the dermatologic diseases found in many patients referred to this type of service.

An analysis of nursing activity in a day care and inpatient dermatology service

The nursing context within which dermatological treatments are provided has received limited investigation. This activity analysis survey examined how nursing time is organized (n=17 nurses) within in- and out-patient day care services in a hospital teaching dermatology department, using a newly developed standardized tool over a 24-week period. The setting was a day care and inpatient facility in a UK dermatology department. Patients (n=108) referred to these services for day care or inpatient care over 24 weeks, excluding emergencies, were recruited consecutively; 76% (n=82) were seen during this time. Most patients (>95%) were referred for clearance of an acute episode of a chronic skin condition and specifically education. The total mean time in contact with the nursing service (mean hours/case) was 43.1 for inpatient and 6.6 for day care. Time in day care was mainly spent (mean hours/case) on direct care (living activities and dermatological treatments) (4.3), followed by teaching (2) and support (1.6). The pattern of inpatient care was similar. A profile has been derived that is indicative of how dermatology nurses spend their time in day and inpatient care. There may be scope for day care nursing to make more effective use of education opportunities to support patient self-management.

Hospitalization for severe skin disease improves quality of life in the United Kingdom and the United States: a comparative study

BACKGROUND

Financial and managerial constraints have resulted in the rationalization of dermatology inpatient services in the United Kingdom and the United States. Therapeutic regimes may vary locally, regionally, and internationally but the clinical outcome of treatment remains the same.

OBJECTIVE

We studied 2 inpatient units: the University of Wales College of Medicine, Cardiff, United Kingdom, and the University of Miami School of Medicine, Miami, Florida, to compare the use and effectiveness of the service provided.

METHODS

Data were collected prospectively from inpatients during a 12-month period. The Dermatology Life Quality Index was administered on admission and after discharge. Data were recorded about the diagnosis, duration of admission, and referring dermatologist.

RESULTS

In all, 295 patients (Cardiff, UK) and 366 patients (Miami, Fla) participated. The average duration of admission in Miami was 6.7 days compared with 14.2 (P <.0001) in Cardiff. In Miami, the most common reasons necessitating admission were extensive disease (54%), the patient being unwell (18%), photophoresis (14%), outpatient treatment failure (8%), and acute deterioration of disease (4%). In Cardiff, the common reasons were acute deterioration (35%), extensive disease (28%), outpatient treatment failure (22%), and liver biopsy (4%). The most common diagnoses in Cardiff were psoriasis (31%) and eczema (26%). In contrast, the most common diagnoses in Miami, were psoriasis (19%), leg ulcers (17%), and mycosis fungoides (14%). The mean Dermatology Life Quality Index value for all patients decreased after admission in Cardiff (14.9-8.2, P <.0001) and Miami (12.0-8.5, P <.0001).

CONCLUSION

Despite the differences in the 2 health care systems, inpatient therapy remains an important and effective therapeutic option in the United States and the United Kingdom.

Pattern of admissions to a tertiary dermatology unit in South Africa

BACKGROUND

There is worldwide recognition of the need to control the rising costs of health-care. As a result there is a trend away from inpatient treatment of people with non-life-threatening skin disorders. In the developing world there is a conflict between the inadequacy of home and community facilities and the need to limit expenditure.

AIM

The aims of this study were to assess the current indications for admission to a dermatology ward, the level of domestic and community facilities among those admitted, and the apparent benefits obtained from such admissions.

METHODS

Over a 6-month period all patients admitted to the tertiary dermatology unit at Groote Schuur Hospital were recruited and a questionnaire was completed by the admitting doctor. On discharge, patients and doctors were asked to assess the level of improvement in the patient's skin disorder.

RESULTS

There were 133 people admitted, with a mean age of 34.1 years (range 1-88). Diagnoses recorded most often were atopic dermatitis (44), other forms of dermatitis (18), psoriasis (21), severe drug reaction (10), leg ulcer (7), skin infection (7) and bullous disease (6). Overall, the extent and severity of the skin involvement was the major indication for admission, although psychosocial problems and a lack of home facilities were contributing factors. A group of 25 people had been admitted to the ward on 2 or more occasions over the preceding 2 years. This group did not differ from the rest of the patients in terms of diagnosis, home circumstances or level of employment.

CONCLUSIONS

Most admissions to a tertiary dermatology unit in Cape Town are for extensive eczema or psoriasis. Most people experience great short-term benefit from inpatient care. The group of people who require repeated admissions do not appear to differ from the total group by diagnosis or available facilities, but may represent a psychosocially vulnerable subset.

Audit of admissions to dermatology beds in Greater Manchester

We present the results of a prospective questionnaire-based audit of admissions to dermatology beds. We examined the admission practices of clinicians and the outcome in terms of benefit to patients. The majority of patients (90%) were admitted because of the severity of their skin disease but other contributing factors included: inability to cope (40%); need for further investigation or observation (33%); coexisting medical factors (17%); poor social support; transport and psychological factors. Most (87%) patients benefited from admission and the dermatology life quality index improved by 42%. We demonstrate that inpatient treatment is effective and improves patients' quality of life.

Inpatient dermatology: characteristics of patients and admissions in a Spanish hospital

BACKGROUND

Inpatient dermatology has not been properly described in many countries. National differences might be important in the evaluation of its usefulness and the applicability of politics of health expenditure restrictions.

OBJECTIVE

To describe inpatient activity and readmission rates in a dermatology department in Spain.

STUDY DESIGN

Cross-sectional prospective study in a single hospital.

SETTING

Secondary care hospital of the National Health Service in Pontevedra (Spain).

METHODS

From May 1997 to December 2000, all discharge sheets (1048) were included in the study, codified and described.

RESULTS

Surgery was the reason for admission in 37% of the inpatients. The most frequent diagnosis were: neoplasm (36%), infection (15%), psoriasis (10%), other (10%), dermatitis (6%) and drug reaction (5%). Readmission rates were 1.8% within 30 days, and 12.5% within 1 year.

CONCLUSIONS

Inpatient dermatology is different in different countries. Compared with what has been described in the USA or UK, our data suggest an important surgical content of inpatient dermatology in Spain, not reported in those countries. Medical diagnoses also differ, consisting of more infections, and less psoriasis and dermatitis in our setting. Readmission rates are low when compared with previously published ones, a finding that supports a long-term benefit of hospitalization.

Inpatient dermatology. A prescription for survival

Currently, only a minority of dermatologists participate in the primary hospital care of patients with severe skin disease. However, an opportunity exists to alter this course. We believe the current course is a detriment to our specialty, and as a specialists we should provide the care for the full spectrum of dermatologic diseases. Moreover, by not delivering complete dermatology care, our specialty also stands to lose respect from both our patients and peers. Our experience at UM suggests that the creation of a cadre of dermatology hospitalists at selected academic medical centers would allow improved patient hospital care, education, and research.